The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population

Abstract Background Adhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population. Methods We used Medicare claims data from 2010–2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case–control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes. Results We found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson’s disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls. Conclusions This investigation identified the burden of AC in the US elderly population and applied case–control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive

Solid state crystal growth of single crystals of 0.75(Na1/2Bi1/2)TiO3-0.25SrTiO(3) and their characteristic electrical properties

Ceramics of composition 0.75(Na1/2Bi1/2)TiO3-0.25SrTiO(3) (NBT-25ST) show a giant electric field-induced strain, making them attractive for actuator applications. Single crystals generally have improved piezoelectric properties over their ceramic counterparts, but the electrical properties of NBT-25ST single crystals have not yet been studied. In this work, NBT-25ST single crystals are grown by the solid state crystal growth technique and their electrical properties measured for the first time. The single crystals show relaxor ferroelectric behavior typical of an NBT-type material. The ferroelectric and inverse piezoelectric properties depend strongly on crystallographic orientation, with superior properties in the (001) orientation. The inverse piezoelectric properties of the (001)-oriented NBT-25ST single crystal are superior to those of an NBT-25ST ceramic (S-max/E-max = 1042 pm/V vs. 739 pm/V)

Erytrocyte membrane anionic charge in type 2 diabetic patients with retinopathy

BACKGROUND: The Steno hypothesis states that changes in basement membrane anionic charge leads to diabetic microvascular complications. In diabetic nephropathy, loss of basement membrane glycosaminoglycans and the association between glomerular basement membrane heparan sulphate and proteinuria has been documented. A correlation between erythrocyte surface and the glomerular capillary wall charges has also been observed. The aim of this study is to evaluate the relationship between retinopathy and erythrocyte anionic charge and urinary glycosaminoglycan excretion in type 2 diabetic patients. METHODS: 49 subjects (58 ± 7 yrs, M/F 27/22) with type 2 diabetes with proliferative retinopathy (n = 13), nonproliferative retinopathy (n = 13) and without retinopathy (n = 23) were included in the study. 38 healthy subjects were selected as control group (57 ± 5 yrs, M/F 19/19). Erythrocyte anionic charge (EAC) was determined by the binding of the cationic dye, alcian blue. Urinary glycosaminoglycan and microalbumin excretion were measured. RESULTS: EAC was significantly decreased in diabetic patients with retinopathy (255 ± 30 ng alcian blue/10(6 )RBC, 312 ± 30 ng alcian blue/10(6 )RBC for diabetic and control groups respectively, p < 0.001). We did not observe an association between urinary GAG and microalbumin excretion and diabetic retinopathy. EAC is found to be negatively corralated with microalbuminuria in all groups. CONCLUSIONS: We conclude that type 2 diabetic patients with low erythrocyte anionic charge are associated with diabetic retinopathy. Reduction of negative charge of basement membranes may indicate general changes in microvasculature rather than retinopathy. More prospective and large studies needs to clarify the role of glycosaminoglycans on progression of retinopathy in type 2 diabetic patients

Development and Evaluation of a Psychosocial Intervention for Children and Teenagers Experiencing Diabetes (DEPICTED): a protocol for a cluster randomised controlled trial of the effectiveness of a communication skills training programme for healthcare professionals working with young people with type 1 diabetes

Background Diabetes is the third most common chronic condition in childhood and poor glycaemic control leads to serious short-term and life-limiting long-term complications. In addition to optimal medical management, it is widely recognised that psychosocial and educational factors play a key role in improving outcomes for young people with diabetes. Recent systematic reviews of psycho-educational interventions recognise the need for new methods to be developed in consultation with key stakeholders including patients, their families and the multidisciplinary diabetes healthcare team. Methods/design Following a development phase involving key stakeholders, a psychosocial intervention for use by paediatric diabetes staff and not requiring input from trained psychologists has been developed, incorporating a communication skills training programme for health professionals and a shared agenda-setting tool. The effectiveness of the intervention will be evaluated in a cluster-randomised controlled trial (RCT). The primary outcome, to be measured in children aged 4-15 years diagnosed with type 1 diabetes for at least one year, is the effect on glycaemic control (HbA1c) during the year after training of the healthcare team is completed. Secondary outcomes include quality of life for patients and carers and cost-effectiveness. Patient and carer preferences for service delivery will also be assessed. Twenty-six paediatric diabetes teams are participating in the trial, recruiting a total of 700 patients for evaluation of outcome measures. Half the participating teams will be randomised to receive the intervention at the beginning of the trial and remaining centres offered the training package at the end of the one year trial period. Discussion The primary aim of the trial is to determine whether a communication skills training intervention for specialist paediatric diabetes teams will improve clinical and psychological outcomes for young people with type 1 diabetes. Previous research indicates the effectiveness of specialist psychological interventions in achieving sustained improvements in glycaemic control. This trial will evaluate an intervention which does not require the involvement of trained psychologists, maximising the potential feasibility of delivery in a wider NHS context. Trial registration Current Controlled Trials ISRCTN61568050

Delphi-Consensus Weights for Ischemic and Bleeding Events to Be Included in a Composite Outcome for RCTs in Thrombosis Prevention

To weight ischemic and bleeding events according to their severity to be used in a composite outcome in RCTs in the field of thrombosis prevention.Using a Delphi consensus method, a panel of anaesthesiology and cardiology experts rated the severity of thrombotic and bleeding clinical events. The ratings were expressed on a 10-point scale. The median and quartiles of the ratings of each item were returned to the experts. Then, the panel members evaluated the events a second time with knowledge of the group responses from the first round. Cronbach's a was used as a measure of homogeneity for the ratings. The final rating for each event corresponded to the median rating obtained at the last Delphi round.Of 70 experts invited, 32 (46%) accepted to participate. Consensus was reached at the second round as indicated by Cronbach's a value (0.99 (95% CI 0.98-1.00)) so the Delphi was stopped. Severity ranged from under-popliteal venous thrombosis (median = 3, Q1 = 2; Q3 = 3) to ischemic stroke or intracerebral hemorrhage with severe disability at 7 days and massive pulmonary embolism (median = 9, Q1 = 9; Q3 = 9). Ratings did not differ according to the medical specialty of experts.These ratings could be used to weight ischemic and bleeding events of various severity comprising a composite outcome in the field of thrombosis prevention

Modelling the duration of residence and plans for future residential relocation: A multilevel analysis

Amongst the multitude of studies of factors that determine residential (im)mobility, relatively little attention has been paid to the length of time that people spend in a particular location and the importance of duration of stay for future relocation propensities. This study uses a large and detailed commercial survey sample of individuals in England and Wales and an appropriately tailored statistical approach to uncover new insights into the multilevel and spatially heterogeneous interactions that exist between residential duration, place attachment and plans for future residential relocation. We demonstrate how an individual’s residential duration, as an essential ingredient for the accumulation of social capital and place-based attachment, is critical for informing plans for future (im)mobility. After controlling for a range of individual and contextual covariates, the predicted probability of planning a residential relocation is found to increase initially with duration of stay, to a peak after 4-5 years, and then to decline as the length of duration increases. However, there is evidence of strong geographical variation in this relationship, with some neighbourhoods being characterised by stable or even increasing propensities for movement with duration. The paper pays particular attention to the importance of wider neighbourhood dynamics (composition, selective sorting and population (in)stability), suggesting that they too play an important role in mediating duration-of-stay effects for individuals. The paper concludes by highlighting the need for researchers and policy practitioners interested in community dynamics, the development/accumulation of social capital and place attachment/rootedness, to give due consideration to multilevel durations of residence and, more broadly, the inherently spatial and temporal ties that bind individuals to place

Learning informally to use the 'full version' of teaching games for understanding

This paper examines an experienced teacher’s employment of the teaching games for understanding (TGfU) model in a UK secondary school. The study sought to investigate how the teacher delivered TGfU and those factors that influenced his informal learning of this instructional model. Occupational socialisation was utilised to determine the factors that influenced his use of TGfU. Qualitative data were collected from interviews, lesson observations and documentary evidence. Inductive data analysis indicated the teacher delivered the ‘full version’ of the model largely congruent with the creators’ intentions. The traditional approach to games teaching seen in his childhood and partially learned in higher education were ‘washed out’ by the influence of teaching colleagues and the development of a student-centred approach to teaching games. This study indicates it is possible to overcome traditional approaches to games teaching and informally learn to use TGfU successfully given conducive circumstances and sufficient time

Patient recall of receiving lifestyle advice for overweight and hypertension from their General Practitioner

BackgroundOverweight, obesity and hypertension can be prevented through improvements in lifestyle including nutrition and physical activity. General practitioners (GPs) in Australia have access to over 90% of the population in the course of a year and therefore, the general practice setting may be ideal to assist patients with lifestyle change for weight management and hypertension. The present study aimed to determine the proportion of overweight/obese patients that recalled receiving advice by their GP to make lifestyle changes for weight loss. Recall of advice received by hypertensive patients to reduce salt intake was also measured.MethodsA face to face survey was conducted on a representative sample (urban, suburban and rural) of South Australian residents. Respondents provided information on height and weight (self-report), whether they had received lifestyle advice from their GP for weight loss, and for those with self reported hypertension if they had received advice to reduce dietary salt.ResultsThe sample included 2947 South Australian adult residents (58% female; BMI (mean (SD)), 26.6 (5.3) kg/m2; age, 50.7 (18.0) years). Ninety-six percent had visited their GP in the past 12 months. Forty-one percent of males and 25% of females were overweight and 19% of males and 20% of females were obese. Twenty-seven percent of overweight/obese respondents reported receiving lifestyle advice for weight loss purposes. Of the 33% who reported they had hypertension, 34% reported receiving advice to reduce salt intake.ConclusionsLess than 1/3 of overweight/obese patients reported that they had received lifestyle advice that could assist with weight loss from their GP. About a third of respondents with hypertension reported that they received advice to reduce salt intake. There are potentially missed opportunities in which GPs could provide re-enforcement of benefits of lifestyle changes with respect to weight and blood pressure control.<br /

Why Are There Social Gradients in Preventative Health Behavior? A Perspective from Behavioral Ecology

Background: Within affluent populations, there are marked socioeconomic gradients in health behavior, with people of lower socioeconomic position smoking more, exercising less, having poorer diets, complying less well with therapy, using medical services less, ignoring health and safety advice more, and being less health-conscious overall, than their more affluent peers. Whilst the proximate mechanisms underlying these behavioral differences have been investigated, the ultimate causes have not. Methodology/Principal Findings: This paper presents a theoretical model of why socioeconomic gradients in health behavior might be found. I conjecture that lower socioeconomic position is associated with greater exposure to extrinsic mortality risks (that is, risks that cannot be mitigated through behavior), and that health behavior competes for people’s time and energy against other activities which contribute to their fitness. Under these two assumptions, the model shows that the optimal amount of health behavior to perform is indeed less for people of lower socioeconomic position. Conclusions/Significance: The model predicts an exacerbatory dynamic of poverty, whereby the greater exposure of poor people to unavoidable harms engenders a disinvestment in health behavior, resulting in a final inequality in health outcomes which is greater than the initial inequality in material conditions. I discuss the assumptions of the model, and it

Development of an Agrobacterium transformation system for onion (Allium cepa L.)

Onion (Allium cepa) bulbs of the New Zealand-bred cultivars 'Pukekohe Longkeeper' and 'Early Longkeeper' produced tumourous growths after inoculation with 25 virulent strains of Agrobactenum tumefaciens, A. rubi and A. rhizogenes. The majority of these tumours produced nopaline, indicating that tumour cells were transformed. Some excised tumours produced roots in sterile culture. Eight onion genotypes were screened in tissue culture for callus formation, regeneration of plantlets from callus and clonal multiplication by shoot proliferation. All genotypes could be clonally multiplied and four were readily regenerable from callus. A technique for plantlet multiplication, which uses longitudinally-bisected stems of in vitro-germinated onion seedlings as explants, was developed. Onion (‘Pukekohe Longkeeper', 'Southport White Globe', 'Japanese Saporo Yellow' and 'Hikeeper Fl ') protoplasts were isolated and cultured on a range of media. These protoplasts formed new cell walls and sometimes divided, but only first divisions were regularly seen. Kanamycin, geneticin (G418), hygromycin and chlorsulfuron were evaluated for their use as selective agents in onion transformation experiments. Tissues surveyed for sensitivity to these selective agents included seeds and seedlings on germination and callusing media, established callus on callusing and regeneration media, and shoot cultures on shoot proliferation medium. Hygromycin was shown to be the antibiotic most toxic to tissues of all the surveyed onion cultivars, with effects being obvious in all tissues after 4-5 weeks of culture on concentrations as low as 20 mgl-1. Kanamycin was shown to be the least toxic of the selection agents surveyed. The kanamycin analogue G418 was considerably more toxic to most onion cultures than kanamycin. However, responses of cultures to G418 were slower than those to hygromycin. The herbicide chlorsulfuron was also shown to be toxic to onion seedlings and shoot cultures. The ability of Agrobacterium tumefaciens to transfer foreign genes to A. cepa was demonstrated. A single, putatively transformed plantlet (RC1), was regenerated from an onion seedling stem via callus, following co-cultivation of stem explants with Agrobacterium strain LBA4404 harbouring the binary vector pKIWI110. In addition, 41 auxiliary or adventitious shoots which grew directly from basal plates injected in vitro with four strains of A. tumefaciens (each harbouring the binary vectors pKIWI110 or pGA643) exhibited resistance to G418 in culture. The binary vectors used carry the neomycin phosphotransferase II gene (nptII) controlled by the nopaline synthase (nos) promoter. Both RC1 and some of the shoots growing from basal plate explants produced roots when grown on culture media supplemented with G418. Southern analyses showed that fragments of DNA from RC1 and from five of the 41 G418-resistant shoots hybridized to a 1.25 kbp nptII probe. (β- glucuronidase (GUS) activity was detected in over half of the plantlets derived from basal plate tissue injected with A. tumefaciens strains LBA4404 or C58, both of which harboured pKIWI110. Molecular and phenotypic evidence suggested that the putatively transformed plants produced from injected basal plate tissues were chimeric